The identified implant systems showed an annual bone loss below or much below what hitherto has been set up as a limit for success. A careful documentation of marginal bone level changes should be mandatory for all implant systems before being marketed. It is also time for revision of existing success criteria to refine the basis for clinical quality judgment of implant treatment.

The aim of this investigation was to evaluate whether augmentation of intramembraneous bone beyond the skeletal envelope can be predictably achieved by placing a completely occlusive barrier on the skull bone of rabbits, hereby creating a secluded space with bone tissue being the only adjoining tissue. The experiment was carried out in 3 New Zealand white rabbits. In each animal, a midline incision was made down to the bone surface of the skull and a skin-periosteal flap was raised to expose the skull bone on both sides of the midline. Two prefabricated titanium domes with an inner diameter of 4.5 mm and an inner height of 3.0 mm were installed on each side. The domes were supplied with a horizontal, peripheral flange and a vertical edge, fitting tightly into a circular slit, prepared by a trephine into the skull bone. This arrangement ensured a stable anchorage of the dome and a reliable peripheral sealing of the space. The skin-periosteal flaps were relocated to cover the domes and sutured. After a healing period of 3 months, the animals were killed and the experimental areas excised and prepared for histological transversal ground sections with each dome in situ. The results demonstrated complete bone fill of all domes, with no signs of ingrowth of other types of tissues, indicating that the use of a barrier with total occlusiveness, sufficient stiffness and stability and reliable peripheral sealing will result in predictable bone augmentation of spaces also beyond the skeletal envelope.

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The aim of the present study was to evaluate if early access to the endosteal bone compartment by removal of the outer cortical bone plate will enhance bone augmentation in a secluded space. Two titanium cylinders were placed on the skull of each of 8 rabbits. Each cylinder was placed into a circular slit, secured to the skull bone via two mini-screws and supplied with a titanium lid. On the test side, the outer plate of the cortical bone, demarcated by the slit, was removed. The subsequent bleeding resulted in blood fill of the cylinders to various degrees. On the control side, the corfical bone plate was left intact and no bleeding was observed at the time of the placement of the titanium lids. After 3 months, the animals were sacrificed to obtain histology and histomorphometry. No differences in the total amount of augmented bone tissue, in relation to the total experimental area (75.5% +/- 10.9% at the test sites and 71.2% +/- 13.5% at the control sites) or of the augmented mineralized bone tissue in relation to the total amount of augmented bone tissue, was revealed (17.8% +/- 3.0% and 16.0% +/- 4.9% respectively). There was no difference in the morphological appearance of the augmented bone between test and control sites and there were no obvious similarities in the appearance between the newly formed bone tissue and the donor bone. The augmented bone consisted of slender bone trabeculae, distributed in abundant marrow spaces. A conspicuous finding was that the bone trabeculae tended to climb along the inner walls of the titanium cylinder. It is concluded that decortication of the calvarial bone in the rabbit does not result in more bone formation beyond the skeletal envelope after a healing period of 3 months compared to no removal of the cortical bone plate inside a secluded experimental area.